POS1097 IMPROVED REFERRALS FROM PRIMARY CARE AND MANAGEMENT OF INFLAMMATORY ARTHRITIS THROUGH AN INTEGRATED COLLABORATIVE ACADEMY AND NETWORK USING BLENDED LEARNING, MENTORING AND ACTION LEARNING SETS
Authors: A. Chan, K. Rigler, J. Kitchen, L. Van Rossen, G. Macdonald, A. Mcdougall, J. Mcnally, S. Melath, A. Mistry
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Improving the delay to diagnosis in inflammatory arthritis remains an important challenge in rheumatology. The National Early Inflammatory Arthritis Audit (NEIAA) in the UK aims to reduce the time to diagnosis through early referral from primary care. In order to achieve this as well as improve the quality of referrals, we have created an integrated Rheumatology Academy and Collaborative Network (RheumACaN) for clinicians in primary care. <h3>Objectives</h3> RheumACaN aims to build confidence in primary care to refer and manage patients with inflammatory arthritis (RA, PsA, AxSpA) as well as other rheumatic diseases. Through integration of pathways from primary to secondary care, RheumACaN aims to reduce delays to diagnosis, improve referral from primary care and enhance management of patients. <h3>Methods</h3> RheumACaN was a 1 year rolling programme with face to face discovery day meetings sharing best practice, teaching and discussion on local referral pathways, guidelines and investigations. In between the face to face sessions there was active learning through virtual mentoring. Participants completed action learning sets, case discussion and the course workbook. The outcome was measured through metrics in the NEIAA, referral patterns and feedback from participants. <h3>Results</h3> RheumACaN was attended by 80 participants over 2 cohorts in 2021-2022 including general practitioners (GPs), community musculoskeletal (MSK) physiotherapists and first contact practitioners (FCPs). Prior to RheumACaN, the number and percentage of patients with suspected early inflammatory arthritis (EIA) referred to a specialist clinic within three working days which is a measure of primary care performance was 109/312 (32%) in 2018/19, 190/334 (57%) in 2019/20, 45/86 (52%) in 2020/21. Post RheumACaN, this increased to 140/201 (70%) in 2021/22. The national average for this metric was 47% in 2019/20 and 54% in 2021/22. Feedback from 2 cohorts was 100% scored 5/5 (excellent) for how well the purpose of the programme was communicated, 100% scored 5/5 for how organised and easy to follow the programme was, 98% scored 5/5 for how engaged the presenters were. All participants responded that they had learned from the programme and this would change their practice. Narrative feedback included: "Very interesting - diagnosis and management, and when to refer onwards, very clear", "Really helpful for future referrals, good tips what to look out for", "Clear criteria and management (onward referral)", "Enjoy discussing the cases and getting feedback, useful to hear other cases", "Great having group discussion, learned so much", "Fantastic afternoon, energising, positive, lots of new ideas/approaches". <h3>Conclusion</h3> We created RheumACaN, a knowledge-sharing model to bring together clinicians from primary and secondary care for a robust, holistic approach to manage rheumatic diseases. Similar models such as project ECHO with the hub and spoke model of 'moving knowledge not people' have been used<sup>[1]</sup>. Our collective understanding of how to disseminate and implement best practices across diverse disciplines resulted in the rapid increase of early referrals of inflammatory arthritis from primary care in our centre which is now above the national average in the UK. New referral quality and outcomes are continuously reviewed with an annual audit to assess impact in line with the NEIAA. RheumACaN has also a train the trainer ethos with participants in Cohort 1 coming back to share and teach Cohort 2. Cohort 1 graduates have also been doing peer to peer teaching sessions to help spread and ensure sustainability. This continuous loop of learning, mentoring and peer support makes this a unique programme, with a long-lasting impact far beyond that of a webinar, e-learning course or seminar, with knowledge which is tested and refined through a local lens. <h3>Reference</h3> [1]Osei-Twum JA et al. Impact of Project ECHO on Patient and Community Health Outcomes: A Scoping Review. Acad Med. 2022 Sep 1;97(9):1393-1402. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Antoni Chan Grant/research support from: The educational programme was funded by a non-promotional grant from UCB, Kathryn Rigler: None declared, Joanne Kitchen: None declared, Liz Van Rossen: None declared, Gordon Macdonald: None declared, Arran McDougall: None declared, Jeremy McNally: None declared, Sunil Melath: None declared, Anna Mistry: None declared.